The proposed research addresses the question, How does the intra- organizational structure of managed care organizations affect the quality of primary care services provided by those organizations? The rapid movement to managed care brings with it uncertainty about the quality of primary care offered by managed care systems. The danger exists that the rush to hold down the cost of care will seriously compromise the quality of primary care and weaken the bond between patient and physician. This project will develop and apply a series of research tools to evaluate the structural relationships within primary care practice groups that are part of managed care systems. The first phase of the research will test these tools within the Palo Alto Medical Clinic, a large, well known medical practice group that is part of Sutter Health Systems. Subsequent phases will use these tools to perform organizational analyses on 50-100 primary care practice units within a variety of managed care systems and settings. The initial request for funding is for phase one only, a twelve month project. In primary care, there are four principal aspects of quality: clinical outcomes, patient satisfaction, the cost of care, and the satisfaction of physicians and other primary care providers. This research addresses the latter three aspects of quality. The research design identifies three major factors that affect primary care quality: the structure of the managed care organization, the structure of the local primary care delivery unit, and the characteristics of the care process. Through initial qualitative research (interviews, direct observation) we will develop a series of variables that reflect each of these factors. The goal of this phase of the research is to identify these variables and to evaluate the feasibility of gathering data pertaining to them on the larger sample identified above. By understanding how the structural characteristics of managed primary care organizations affect the quality of that care, it will be possible to do two things: those who evaluate managed care plans from the patient's perspective will be able to identify specific organizational characteristics that are indicators of high quality primary care; those who manage these plans will have information about what organizational changes might be made to increase primary care quality.